468 Nursing Homes and Chronic Mental Patients

Nursing homes play an important and controversial role in the community-based care of chronic mental patients. Confronting the reality of this role can help us rec-ognize problems in the rationales for deinstirutionalization and community care. Problems with three concepts that were central fo deinstirutionalization are examined—the total institution, institutional neurosis, and social reintegration. Furthermore, two concepts are presented that were overlooked in the haste to initiate deinstitutionalization—custody, asylum, and treatment functions in society; and the role of patient expectations. Finally, suggestions are made about how nursing homes can play a more construc-tive role in mental health policy. More than 20 years ago, a conver-gence of circumstances gave impe-tus to the movement we now refer to as deinstitutionalization—mov-ing mental patients out of mental hospitals. Among the most impor-tant influences in this trend were the introduction of effective psychotropic medications, the community mental health pro-gram, court decisions, and changes in administrative and fis-cal policies (Bachrach 1976; Barnett 1978; Segal and Aviram 1978). Data are now available which doc-ument the changes in location of treatment that have occurred since deinstitutionalization began (e.g.